Adolescent Escort Service

Primary specialty

Private VehicleTaxonomy code 347C00000X

License

1796 Issued in UT

Legal business name

ADOLESCENT ESCORT SERVICE

Practice address

1865 S Cantle Cir
Washington, UT 84780-2121

Phone

(435) 701-6984

NPI assigned

Apr 22, 2014

Last updated

Apr 22, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ian Gerritsen

Title

Owner

Phone

(435) 701-6984

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1398124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398124800000",
    "number": "1851711477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1865 S CANTLE CIR",
            "city": "WASHINGTON",
            "state": "UT",
            "postal_code": "847802121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1865 S CANTLE CIR",
            "city": "WASHINGTON",
            "state": "UT",
            "postal_code": "847802121",
            "telephone_number": "435-701-6984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADOLESCENT ESCORT SERVICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-22",
        "last_updated": "2014-04-22",
        "status": "A",
        "authorized_official_last_name": "GERRITSEN",
        "authorized_official_first_name": "IAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "435-701-6984"
    },
    "taxonomies": [
        {
            "code": "347C00000X",
            "taxonomy_group": "",
            "desc": "Private Vehicle",
            "state": "UT",
            "license": "1796",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Private Vehicle in Washington, UT
• Providers in Washington, UT by specialty
• Private Vehicle in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.